Abstract
Purpose :
Pivotal clinical trials of faricimab for neovascular age-related macular degeneration (nAMD) reported vision gains similar to aflibercept, greater reduction in central subfield thickness and more durable efficacy. We have analysed retrospective data from an observational database to establish whether the same outcomes can be achieved in routine clinical practice
Methods :
Retrospective analysis of data from the prospectively designed Fight Retinal Blindness! outcomes registry, which uniquely collects 100% complete and in-range observational outcomes data for nAMD. Eyes with nAMD that switched from a 1st generation VEGF inhibitor with ≥ 6 months of follow-up from the first faricimab injection were identified. The primary outcome was activity of the choroidal neovascular membrane; secondary outcomes included visual acuity (VA), treatment interval and ocular adverse events.
Results :
192 eyes patients switched to faricimab from aflibercept (66%), followed by ranibizumab (15%), brolucizumab (2.3%) and bevacizumab (0.7%) after a median of 27 injections over a median of 1185 days. Mean visual acuity was good (71.2 LogMAR letters) with a median injection interval of 42 days at the time of switching. The proportion of inactive eyes increased significantly from 33% to 51% (p<0.001) 6 months later. Mean (SD) treatment interval increased from 43.7 (15.6) to 53.2 (18.5) days (p<0.001). Mean VA was similar: 71.2 (13.4) at switch vs 70.4 (13.6) 6 months later (p=0.10). Of the 128 (67%) eyes that had active lesions at the switch, 39% became inactive and the interval increased from 42.0 (14.4) to 50.4 (18.6) days (p<0.001) with no change in vision. A quarter of the remaining 63 eyes, that had inactive lesions at the switch, reactivated with treatment interval increasing from 47.3 (17.4) to 59.6 (16.7) days (p<0.001) and a slight drop in vision from 72.3 (12.2) to 70.3 (12.5) letters (p<0.01). There were no serious adverse events including any intraocular inflammation.
Conclusions :
Faricimab treatment in real world practice inactivated a significant number of CNV lesions that had been active using 1st generation VEGF inhibitors with significantly longer treatment intervals and generally stable vision. Longer-term analyses will give a better idea of long-term outcomes.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.